Where does NHS Continuing Care apply?

NHS continuing care can be provided in a care home, hospice or the home of the person who need care. If someone in a care home is eligible for NHS continuing healthcare, this will cover all care home fees, including cost of accommodation, personal care and healthcare.

If NHS continuing healthcare is provided at home, it covers personal care and healthcare costs. It may also include support for carers.

Who is eligible?

To be eligible for NHS continuing healthcare, the person must be assessed as having a “primary health need” and have a complex medical condition and ongoing care needs.

Not everyone with long-term condition or disability is eligible. The assessment for NHS continuing healthcare is supposed to be “person centred”, i.e. the person being assessed should be fully involved in the assessment process. Their views about their own needs and support should be taken into account and they should be kept fully informed about the process. Carers are also involved where appropriate.

A decision about eligibility should usually be made within 28 days of an assessment being carried out.

What happens if your parent is not eligible?

If your parent doesn’t qualify for NHS continuing healthcare, their local authority will be responsible for their care assesssment and providing services if the local authority deems them to be eligible under their own care assessment schemes.

If your parent doesn’t qualify for NHS continuing healthcare, but is assessed as having care or nursing needs, they can still receive some care from the NHS. For someone in their own home, this could be part of a joint package of care, with some services coming from the NHS and some from social services. If your parent moves into a nursing home, the NHS may contribute towards nursing care costs.

Care services from the local authority are usually means-tested, so if your parent is eligible for local authority care, their finances will be assessed. Depending on income and savings, they may need to pay towards their care costs.

NHS Continuing Care Assessment Process

Primary care trusts must carry out an assessment for NHS continuing care if it seems that someone may need it. For example, the assessment should be carried out:

• if someone’s physical or mental health worsens significantly
• before someone is awarded NHS-funded nursing care
• when someone is discharged from hospital

You can also ask for an assessment for your parent by talking to a health or social care workers or the NHS continuing healthcare coordinator at your parent’s primary care trust. You can find out the name of your local co-ordinator by asking your GP, or contacting the local Patient Advice and Liaison Service, or contacting your parent’s Clinical Commissioning Group directly.

Initial assessment

The initial assessment is a checklist, completed by a nurse, doctor, other healthcare professional or social worker. Your parent should be told what’s happening, and be asked for their consent.

Depending on the outcome, your parent will be told that they’re not eligible for NHS continuing healthcare, or if they are eligible, they will be referred for a full assessment. Being referred for a full assessment doesn’t necessarily mean your parent will ultimately be eligible for NHS continuing care.

Whatever the decision, the professional completing the checklist should provide written reasons for their decision, and sign and date the checklist. Your parent should be given a copy of the completed checklist. You can download a blank copy of the NHS continuing care checklist from GOV.UK.

Full assessment

When your parent has a full assessment for NHS continuing healthcare, a multi-disciplinary team will assess their care needs, made up of health and social care professionals already involved in their care.

This team will use a “decision support tool” to decide your parent is eligible for NHS continuing care. The assessment looks at the following areas:

• behaviour
• cognition (understanding)
• communication
• psychological/emotional needs
• mobility
• nutrition (food and drink)
• continence
• skin (including wounds and ulcers)
• breathing
• symptom control through drug therapies and medication
• altered states of consciousness

Those carrying out the assessment should look at what help is needed, how complex the needs are and assess any risks that would exist if adequate care was not provided. For each of these issues a decision is then made about the level of need, marked “priority”, “severe”, “high”, “moderate” or “low”.

If your parent has at least one priority need, or severe needs in at least two areas, they should be able to get NHS continuing healthcare. Someone can also qualify if they have a severe need in one area, plus a number of other needs, or a number of high or moderate needs.

The assessment should consider your parent’s and your own views and you should be given a copy of the completed decision support tool document with clear reasons for the decision.

Fast-track assessment

If someone’s condition is deteriorating fast, they should be assessed under the NHS continuing care fast track pathway, so that an appropriate care package can be put in place as soon as possible.

Government guidance says that care should be put in place within 48 hours of someone being found eligible under the fast track pathway.

For more information, visit the NHS